South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Although the removal of hair as a pre-operative preparation of the skin is desirable, it need only be removed over an area limited to a planned incision, and then only in hirsute patients. The use of a depilatory cream as an alternative to a razor would seem to have the advantages of increasing patient comfort; of avoiding injuries inflicted by even skilful shaving; and perhaps of diminishing the incidence of wound infection, without significant risk of reaction to the depilatory. Routine extensive pre-operative hair removal in all patients is unnecessary.
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Comparative Study Clinical Trial Controlled Clinical Trial
Intravenous ketamine for postoperative analgesia.
Thirty-six consecutive patients who had undergone major surgery were carefully studied for 6 hours postoperatively in an attempt to evaluate the relative analgesic and respiratory-depressant effect of morphine, ketamine, and placebo administered by continuous intravenous infusion. Side-effects, vital signs and respiratory measurements were recorded hourly by a consultant physician. With regard to the dosage and method of administration, ketamine was shown to be less effective than morphine for the first 3 hours postoperatively, but equally effective subsequently, whereas the patients who received ketamine showed a greater progressive tendency for their respiratory parameters to improve with time. Recommendations regarding the postoperative control of pain are made, and the need for further study is noted.
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An approach to the diagnosis and management of accidental haemorrhage with associated coagulation failure is discussed and outlined. It is stressed that special investigations play a minor role in planning management. The main aim should be to achieve rapid delivery, preferably via the vaginal route. ⋯ Life-endangering complications such as acute respiratory and renal failure should be prevented by prophylactic management and by treatment aimed at rapid delivery. The indications for Caesarean section are outlined. The need for careful assessment prior to discharge of these patients and for re-assessment throughout the puerperium is stressed.
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In 50 healthy mothers scheduled for elective Caesarean section, anaesthesia was induced with propanidid (7 mg/kg body weight). Thereafter, ventilation was controlled with nitrous oxide, oxygen and muscle relaxants. A further dose of propanidid (1 mg/kg body weight) was administered 3 minutes after the initial injection of this drug, as a means of preventing maternal awareness during equilibration with the anaesthetic gas mixture. ⋯ Nausea and vomiting occurred in 5 patients and in 4 there were clinical signs of postoperative chest infection. The degree of fetal biochemical asphyxia, and the incidence of maternal awareness during surgery, were significantly greater than previously reported when thiopentone was used for the induction of anaesthesia for Caesarean section. The results obtained are discussed, and the conclusion is drawn that propanidid for anaesthesia appears to offer no advantage over thiopentone in obstetric practice.
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Anaesthesia was induced with Alfathesin (60 - 70 mul/kg) in 50 healthy mothers undergoing elective Caesarean section. Anaesthesia was maintained with nitrous oxide, oxygen, muscle relaxants and controlled ventilation. ⋯ Blood gas studies done on the mothers before induction and at delivery, revealed a mild respiratory alkalosis associated with a moderate degree of metabolic acidosis, which appeared to increase during anaesthesia. Umbilical cord blood gas analyses indicated a mild degree of fetal respiratory acidosis (mean pCO2 Uv 45,3